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1.     
In some capacity, have you ever acted as a
caregiver to someone?



 
Yes
 
No
 
 






1.     
At any point, were the demands of taking care of
this individual overwhelming?



NoYes
1
2
3 4 5
Please rate accordingly
 
 






1.     
How often were you faced with scheduling conflicts
between your personal schedule and the individual’s schedule?



Not oftenVery often
1 2 3 4 5
Please rate accordingly
 
 






1.     
Would it have been helpful to have additional assistance
taking care of this individual?



UnhelpfulVery helpful
1 2 3 4 5
Please rate accordingly
 
 






1.     
How much value, if any, do you see in a service
that will bring this individual to their medical, dental or non-emergency
appointments?  



No valueSignificant value
1 2 3
4 5
Please rate accordingly
 
 






1.     
How much, if any, value to do you see in a
service that will enable you to utilize a booking system to schedule



No valueSignificant value
1
2
3 4 5
Please rate accordingly
 
 






1.      How willing are you to pay for this type of
service?



UnwillingVery willing
1 2 3 4 5
Please rate accordingly
 
 
 
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